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Unlike previous studies on this topic, our study specifically delves into the effectiveness and drawbacks of various treatment approaches such as traditional wastewater treatment facilities (WWTP), membrane bioreactors (MBRs), constructed wetlands (CW), and moving bed biofilm reactors (MBBR). Through the examination and synthesis of information gathered from more than 200 research studies, we have created a comprehensive database that delves into the effectiveness of eliminating 19 particular PhCs, including commonly studied compounds such as acetaminophen, ibuprofen, diclofenac, naproxen, ketoprofen, indomethacin, salicylic acid, codeine, and fenoprofen, amoxicillin, azithromycin, ciprofloxacin, ofloxacin, tetracycline, atenolol, propranolol, and metoprolol. This resource provides a depth and scope of information that was previously lacking in this area of study. Notably, among these pharmaceuticals, azithromycin demonstrated the highest removal rates across all examined treatment systems, with the exception of WWTPs, while carbamazepine consistently exhibited the lowest removal efficiencies across various systems. The analysis showcases the diverse results in removal efficiency impacted by factors such as system configuration, operation specifics, and environmental circumstances. The findings emphasize the critical need for continued innovation and research, specifically recommending the integration of advanced oxidation processes (AOPs) with existing biological treatment methods to improve the breakdown of recalcitrant compounds like carbamazepine.<\/jats:p><\/jats:sec><jats:sec><jats:title>Practitioner Points<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>Persistent pharmaceuticals harm aquatic ecosystems and human health.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Biological systems show varying pharmaceutical removal efficiencies.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Enhancing HRT and SRT improves removal but adds complexity and costs.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Tailored treatment approaches needed based on contaminants and conditions.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><\/jats:sec>","DOI":"10.1002\/wer.11153","type":"journal-article","created":{"date-parts":[[2024,11,14]],"date-time":"2024-11-14T07:09:22Z","timestamp":1731568162000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Insights into the efficiencies of different biological treatment systems for pharmaceuticals removal: A review"],"prefix":"10.1002","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0095-7713","authenticated-orcid":false,"given":"Armin","family":"Dolatimehr","sequence":"first","affiliation":[{"name":"Master of Water and Hydraulics, Independent Researcher Islamic Azad University  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Mahyar","sequence":"additional","affiliation":[{"name":"Brandenburg University of Technology (Cottbus\u2010Senftenberg) Volmerstr  Berlin 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